Monica Fukala

Key facts

NPI

1477075323

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

22783 (TN)

Practice address

7945 Wolf River Blvd
Germantown, TN 38138-1762

Phone

(901) 683-0055

Fax

(901) 685-2969

NPI assigned

Jul 12, 2017

Sex

Female

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Medicine PC Internal Medicine Physician · Livonia, MI · NPI 1376623736
  Medicare reassignment Care Compare group NPD MI · MULTI-SPECIALTY

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Premier Medicine PC (12 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16805/brand/1/csg/1/fhir/r4
• Direct secure messaging: monica.fukala.1@16805.direct.athenahealth.com

Specialties & licenses

Addresses

Other names

• Monica Lee Specht Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 16, 2017.

{
    "created_epoch": "1499817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1510790400000",
    "number": "1477075323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7714 POPLAR AVE STE 200",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381383941",
            "telephone_number": "901-683-0055",
            "fax_number": "901-922-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7945 WOLF RIVER BLVD",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381381762",
            "telephone_number": "901-683-0055",
            "fax_number": "901-685-2969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKALA",
        "first_name": "MONICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-12",
        "last_updated": "2017-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "22783",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "22783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONICA",
            "last_name": "SPECHT",
            "middle_name": "LEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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All providers in Germantown, TN · Family Nurse Practitioner in Tennessee